Ask D'Mine: Coping with Fear, About Those Blood Drops...

Written by Wil Dubois
| Published on October 15, 2011

October is the month for fear and blood, no doubt. We're right on message in this week's edition of our diabetes advice column, Ask D'Mine, hosted by veteran type 1, diabetes author and community educator Wil Dubois.

Thanks to all for sending us your queries related to life with diabetes — nothing is off-limits here! (except of course specific medical instructions for your own care; that's what doctors are for)

Gary from Oklahoma, type 1, writes:I'm newly diagnosed with type 1 diabetes, and I'm scared out of my wits. When does this feeling go away? What can I do to cope with the "fear factor?"

Wil@Ask D'Mine answers: What's scarier: Being in a crowded life boat in shark-filled waters watching the ship sink, or being on the sinking ship watching the over-filled life boat bobbing around in the shark filled waters?

Well, come to think of it, I guess they're both equally scary, but I think we can all agree that being in the lifeboat is the more enviable place to be, given the two options.

Gary, welcome to the lifeboat.

Type 1 diabetes can be scary. There's a lot to learn. A lot of things have changed. Your own mortality has just been brought into sharp focus. But the good news is you're not alone, and that's the best medicine for your fear. In fact, you've already taken your first dose! You found us. That means you've found the Diabetes Online Community, called the DOC. I personally find that name highly appropriate, even though it was accidental (some members call it the Dee-Oh-See, but I pronounce it 'the Doc,' as do many others).

The reason I find the name of our online world so appropriate is that the DOC is a doctor of sorts. Oh dear. Did you hear that sound? That's the folks at the AMA sharpening their pitch forks and lighting their torches again to deal with me once and for all. So let me quickly state that the DOC not a place for specific medical treatment advice.

But the DOC is a great prescription for fear, and a great antidote to the feeling of being all alone. When you poke around the diabetes corner of the internet you'll find blogs written by people like you. People who started out scared out of their wits. People who aren't scared anymore. You'll find communities where you can engage with others of your kind. Others who may be more scared, or less. You'll find news and information. And support. It's a community in all the best senses of the word.

Oh. Right. And you'll also find some complete BS, too, because anyone can say anything online. Caveat emptor. That's Latin for the oldest consumer advice in the world. It comes to us from the ancient Romans. It translates to buyer beware. So if someone wants to sell you a "proven cure" for diabetes, ya might want to ask your doctor first.

But to cure your fear, you've come to the right place.

Lynn from North Carolina, type 2, writes:I read that you should NEVER use the first drop of blood from your finger, but rather squeeze one drop, wipe it off, then use the SECOND drop, because the blood is from the vein and gives a more accurate reading. Is this correct? I hate the idea of having to squeeze out so much blood every time, especially when I'm trying to test more often.

Wil@Ask D'Mine answers: You should test the first drop if the British are coming by land, and the second drop if they are coming by sea.

But seriously, relax. You've been reading old material.

Give your poor little fingers a break. The first drop is fine. But the legacy of the old info is kinda interesting.

The first thing you need to know is that even with the biggest, deepest, nastiest lancing needle you can find, you won't be testing blood from a vein. Fingersticks tap into capillary beds. Capillaries are microscopic itsy, tiny bottom-of-the-totem-pole parts of the circulatory system.

The second thing you need to know is that before the dawn of the glucose meter there were other medical tests that used capillary blood from fingersticks, too.

The third thing you need to know is people used to worry that poking a bunch of holes in the skin could lead to infection. (This has been proven to be false.) Thus, for many years, we PWDs were advised to clean our fingers with an alcohol pad before testing.

OK, now to the distant, dark origins of the two-drop recommendation. Many of the capillary blood lab tests take a lot of blood. In fact, back in the day, when dinosaurs ruled the Earth, our blood glucose metersrequired a lot more blood than they do now. When you poke a hole in your skin, blood platelets start to aggregate, forming a platelet "plug." Yeah. The little Dutch boy with his finger in the dyke. It's the body's first step at making a blood clot. The problem here, of course, is you don't want the finger to stop bleeding before you can get enough blood for whatever test you are trying to run. Wiping away the first drop wipes away the initial platelet plug and lets the finger bleed longer. Of course modern blood glucose machines need only ridiculously small drops of blood, so this really isn't an issue anymore.

Similar other-lab-test-worries also carry a legacy to this day. The first drop of blood sometimes has more "tissue fluid" and/or higher potassium levels, either of which can effect some other tests, but have no relevance to the accuracy of a blood sugar test.

And remember that whole alcohol pad thing? Well, back when we were told to use them, folks would often rush to test before the finger was dry (or blow on the finger, defeating the alleged purpose of making the finger sanitary). With a wet finger, the first drop is half alcohol and half blood. The second drop was more likely pure blood.

Not surprisingly, using an alcohol pad is no longer recommended. It's not necessary and there're no documented cases of infections from finger lancing (clarification, never share your gear), and as noted, use of an alcohol pad can throw off the results from some meters.

So that's the myth's origin — the Garden of Eden story for the two-drop recommendation. A long time ago in a galaxy far, far away we needed more blood, we worried about the mix of body fluids in the first sample, and we worried about mixing the sanitizing alcohol with the blood sample. All false worries in our modern world. Just make sure you finger is clean and you're good to go. A quick wash with soap and water will remove the cake frosting from your fingertips.

Of course, you'll still meet some older and/or out of date medical pros who will tell you to do the double wipe thing. And at some hospitals and clinics they still do it because some of those other lab tests still need a ton of blood and it's easier to teach staff to do all lancing samples one way than to expect them to remember many different rules.

But for us at home, just drink the first drop.

And just for the hell of it, I whipped out my Presto meter just now, did a first-drop test, and got a 205 mg/dL. Then I wiped the drop away and squeezed out another drop. The second drop tested at 202 mg/dL. The two readings are well within the expected accuracy range of the meter.

Science in action. There's no statistical difference between the two readings.

What's my blood sugar doing in the 200s, you ask? Ummmmmmm..... I think I might have mentioned that I'm a better tour guide than a role model...

This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a small part of your total prescription. You still need the professional advice, treatment, and care of a licensed medical professional.

Disclaimer: Content created by the Diabetes Mine team. For more details click here.

Disclaimer

This content is created for Diabetes Mine, a consumer health blog focused on the diabetes community.
The content is not medically reviewed and doesn't adhere to Healthline's editorial guidelines.
For more information about Healthline's partnership with Diabetes Mine, please click here.

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Archived Comments

maggie|2011-10-15

Huh. I never knew you're not supposed to use alcohol swabs. Guess I'll take those off my shopping list. Thanks!

Allison|2011-10-15

I stopped using alcohol pads really soon after I was diagnosed 16 years ago, but I did hear a horror story about someone who always tested on her pinky and then sucked it clean after - she had to have the finger amputated. I'm guessing there was more to it but it's kept me from ever doing that! I'll keep using my bloody tissue! haha

Penny|2011-10-15

Thanks Wil - good info. And Gary from OK, welcome to the DOC! We are glad you are here, what with the 'club you never wanted to join' mentality - we are glad you are here anyway!As for the alcohol pads - my gal is 9, diagnosed 3 years ago and we maintained strict vigilance with alocohol pads for about 3 months - until her fingers were SO dried out from all that alcohol. And plus, she would complain the pricker hurt sometimes on her fingers. We haven't looked back since. We only use soap and water if we think something is on her hands, otherwise, game on.

Natalie|2011-10-17

Wil, you bring back memories of the old hanging drop of blood meters, and the timing, then wiping the strip, then timing the strip in the meter for a total of 2 minutes for your reading!!!!Yes, I was taught to wipe with alcohol, but soon discontinued it. I do use alcohol for my pump and CGM sites, not for sanitation, but because alcohol dissolves the body oils and makes the sites stick better. I also use a tissue to clean my finger after a test -- I HAVE seen people licking their fingers after a test, but it seems too risky to me. I have a folded tissue right there in my meter case, and it has lots of spots of dried blood on it -- but no one but me needs to look at it!And YOU KNOW what to do when your BG is in the 200's!!!!! :-)

Seth Bernstein|2011-10-18

To Gary from OK- Gary, I suggest that you do a fingerstick test before going to sleep and before driving a car. Although low blood sugar is not very nice, you certainly want to avoid it while asleep or driving.

Chris k|2011-10-19

This makes me think of a related question I've always wondered:How much can moisture on your hands throw off the BG reading? Should I make sure my hands are completely dry after washing them or swimming? Can excessive sweat throw off the numbers too?

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